CA DHMO Participating Offices Language Assistance Program

California law requires health plans to provide free language assistance services. This assistance includes the translation of vital plan documents into Spanish, as well as a provision for interpretive services in any language. As a result, all provider contracts issued, amended, delivered or renewed must require compliance with the plan's Language Assistance Program (LAP) effective January 1, 2009.

If a patient is unable to effectively respond to routine questions asked by your office staff in English, the patient will be considered a Limited English Proficient (LEP) enrollee and you may contact United Concordia for interpretive and translation services available at no charge to you or the enrollee. To avoid communication complications, you may verify your patient's language preference on My Patients' Benefits prior to scheduling their appointment.

Pursuant to California law, United Concordia established a Language Assistance Program, which provides for the translation of certain plan documents into Spanish and interpretation services in any language regarding dental treatment. United Concordia surveyed its California members to determine their spoken and written language preferences. If you would like to know your patient's language preferences, please call United Concordia at (800) 332 0366 for FFS, (800) 866 8499 for DHMO, or access My Patients' Benefits.

Enrollee Notice - This notice should also be posted in a highly visible location in your waiting and treatment rooms.

Get Help Now Notice (English)
Get Help Now Notice (Spanish)

Language Capabilities Disclosure Form - Participating offices are required to inform insurers of the languages fluently spoken by office staff. This information must also be submitted on a quarterly basis to ensure that members seeking care have access to up-to-date information. Please complete and fax the enclosed Language Capabilities Disclosure Form to (866) 223 2770.

Language Capabilities Disclosure Form (DHMO and PPO)

Request/Refusal for Interpretive Services Form - If you treat a LEP member, this form should be completed and placed in the member's dental record.

Request/Refusal for Interpretive Services Form

Grievance/Dissatisfaction Form - If you treat a LEP member who wishes to file a grievance, this form should be provided in the member's language preference.

Grievance/Dissatisfaction Form (English)
Grievance/Dissatisfaction Form (Spanish)